<p>Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure</p>

Abstract

Since its introduction in 1985 with Ciaglia, percutaneous tracheostomy (PT) was contraindicated in emergency settings and obesity. However, several case series in the last 20 years have documented the use of PT in life-threatening airway emergencies. We present a case of severe acute airway obstruction in a 66-year-old woman successfully treated with a placement of an awake PT. The woman’s glottic obstruction was caused by a recurrent laryngeal neoplasia and revealed by nasoendoscopy. This acute condition required a serious effort from the patient to oxygenate and therefore prevented orotracheal intubation as well as the use of any supraglottic device and/or sedation. Blood aspiration after a first attempt to make a quick access to the tracheal lumen with an emergency cricothyroidotomy, and difficulties in the exact identification of tumor infiltration, led us to perform an awake tracheostomy. Due to elevated risk of airway bleeding, we started with a surgical approach to better identify anatomical structures. After the correct inter-tracheal ring space identification, sudden worsening of clinical symptoms required that we complete the procedure quickly with the aid of a Ciaglia Blue Rhino™-Cook (CBR) tracheostomy kit. At the tracheostomy tube placement, the patient quickly resolved her dyspnea and physiological breathing was restored.

Anesthetic management for emergency tracheostomy in patients with head and neck cancer: a case series

“…In cases of upper airway obstruction where endotracheal intubation is expected to be very difficult or impossible, securing an airway through tracheostomy is sometimes necessary [ 2 ]. Airway obstruction and associated symptoms due to upper airway involvement are frequent [ 9 ]. Among the indications for tracheostomy defined by the American Academy of Otolaryngology (AAO), many symptoms can be present in patients with advanced malignancy of the head and neck [ 3 4 5 ].…”